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Emergency Department Door-to-Puncture Time Since 2014.
Czap, Alexandra L; Grotta, James C; Parker, Stephanie A; Yamal, Jose-Miguel; Bowry, Ritvij; Sheth, Sunil A; Rajan, Suja S; Hwang, Hyunsoo; Singh, Noopur; Bratina, Patti; Bryndziar, Tomas; Alexandrov, Andrei V; Alexandrov, Anne W; Dusenbury, Wendy; Swatzell, Victoria; Jones, William; Ackerson, Kimberly; Schimpf, Brandi; Wright, Patrick; Jagolino-Cole, Amanda L.
Afiliación
  • Czap AL; From the McGovern Medical School at the University of Texas Health Science Center, Houston (A.L.C., S.A.P., R.B., S.A.S., P.B., A.L.J-C.).
  • Grotta JC; Memorial Hermann Hospital, Houston, TX (J.C.G.).
  • Parker SA; From the McGovern Medical School at the University of Texas Health Science Center, Houston (A.L.C., S.A.P., R.B., S.A.S., P.B., A.L.J-C.).
  • Yamal JM; School of Public Health at the University of Texas Health Science Center at Houston (J.-M.Y., S.S.R., H.H., N.S.).
  • Bowry R; From the McGovern Medical School at the University of Texas Health Science Center, Houston (A.L.C., S.A.P., R.B., S.A.S., P.B., A.L.J-C.).
  • Sheth SA; From the McGovern Medical School at the University of Texas Health Science Center, Houston (A.L.C., S.A.P., R.B., S.A.S., P.B., A.L.J-C.).
  • Rajan SS; School of Public Health at the University of Texas Health Science Center at Houston (J.-M.Y., S.S.R., H.H., N.S.).
  • Hwang H; School of Public Health at the University of Texas Health Science Center at Houston (J.-M.Y., S.S.R., H.H., N.S.).
  • Singh N; School of Public Health at the University of Texas Health Science Center at Houston (J.-M.Y., S.S.R., H.H., N.S.).
  • Bratina P; From the McGovern Medical School at the University of Texas Health Science Center, Houston (A.L.C., S.A.P., R.B., S.A.S., P.B., A.L.J-C.).
  • Bryndziar T; The University of Tennessee Health Science Center, Memphis (T.B., A.V.A., A.W.A., W.D., V.S.).
  • Alexandrov AV; The University of Tennessee Health Science Center, Memphis (T.B., A.V.A., A.W.A., W.D., V.S.).
  • Alexandrov AW; The University of Tennessee Health Science Center, Memphis (T.B., A.V.A., A.W.A., W.D., V.S.).
  • Dusenbury W; The University of Tennessee Health Science Center, Memphis (T.B., A.V.A., A.W.A., W.D., V.S.).
  • Swatzell V; The University of Tennessee Health Science Center, Memphis (T.B., A.V.A., A.W.A., W.D., V.S.).
  • Jones W; The University of Colorado, Denver (W.J., K.A.).
  • Ackerson K; The University of Colorado, Denver (W.J., K.A.).
  • Schimpf B; The University of Colorado Hospital, Denver (B.S.).
  • Wright P; The University of Colorado, Colorado Springs (P.W.).
  • Jagolino-Cole AL; From the McGovern Medical School at the University of Texas Health Science Center, Houston (A.L.C., S.A.P., R.B., S.A.S., P.B., A.L.J-C.).
Stroke ; 50(7): 1774-1780, 2019 07.
Article en En | MEDLINE | ID: mdl-31182000
Background and Purpose- The impact of a mobile stroke unit (MSU) on access to intraarterial thrombectomy (IAT) is a prespecified BEST-MSU substudy (Benefits of Stroke Treatment Delivered Using a Mobile Stroke Unit Compared to Standard Management by Emergency Medical Services). On the MSU, IAT decision-making steps, such as computed tomography, neurological exam, and tPA (tissue-type plasminogen activator) treatment are completed before emergency department arrival. We hypothesized that such pre-ED assessment of potential IAT patients on an MSU improves the time from ED arrival to skin puncture time (door-to-puncture-time, DTPT). Methods- BEST-MSU is a prospective comparative effectiveness study of MSU versus standard management by emergency medical services (EMS). We compared ED DTPT among the following groups of MSU and EMS patients: all IAT patients, IAT patients post-tPA, and IAT patients post-tPA meeting thrombolytic adjudication criteria over the first 4 years of the study. Results- From August 2014 to July 2018, a total of 161 patients underwent IAT. Ninety-four patients presented to the ED via the MSU and 67 by EMS. One hundred forty patients received tPA before IAT, 85 in the MSU arm, and 55 in the EMS arm. One hundred twenty-six patients received tPA within thrombolytic adjudication criteria: 76 MSU and 50 EMS. DTPT in minutes was shorter for MSU patients (all IAT MSU versus EMS 89 versus 99, P=0.01; IAT post-tPA MSU versus EMS 93 versus 100, P=0.03; and IAT post-tPA within adjudicated criteria MSU versus EMS 93 versus 99.5, P=0.03). From 2014 to 2018, DTPT decreased at a faster rate for EMS compared with MSU-managed patients, improving by about an hour. Conclusions- Pre-ED IAT evaluation on an MSU results in faster DTPT compared with arrival by EMS. Since 2014, dramatic improvement in ED IAT metrics has attenuated this difference. However, DTPT in all groups indicates substantial room for improvement.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ambulancias / Accidente Cerebrovascular / Servicio de Urgencia en Hospital / Tiempo de Tratamiento Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Ambulancias / Accidente Cerebrovascular / Servicio de Urgencia en Hospital / Tiempo de Tratamiento Tipo de estudio: Clinical_trials / Observational_studies / Prognostic_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: Stroke Año: 2019 Tipo del documento: Article Pais de publicación: Estados Unidos